Abstract
BackgroundFollow-up visits with clinic providers after hospital discharge may not be feasible for some patients due to functional limitations, transportation challenges, need for physical distancing, or fear of exposure especially during the current COVID-19 pandemic.MethodsThe aim of the study was to determine the effects of post-hospital clinic (POSH) and telephone (TPOSH) follow-up provider visits versus no visit on 30-day readmission. We used a retrospective cohort design based on data from 1/1/2017 to 12/31/2019 on adult patients (n = 213,513) discharged home from 15 Kaiser Permanente Southern California hospitals. Completion of POSH or TPOSH provider visits within 7 days of discharge was the exposure and all-cause 30-day inpatient and observation stay readmission was the primary outcome. We used matching weights to balance the groups and Fine-Gray subdistribution hazard model to assess for readmission risk.ResultsUnweighted all-cause 30-day readmission rate was highest for patients who completed a TPOSH (17.3%) followed by no visit (14.2%), non-POSH (evaluation and management visits that were not focused on the hospitalization: 13.6%) and POSH (12.6%) visits. The matching weighted models showed that the effects of POSH and TPOSH visits varied across patient subgroups. For high risk (LACE 11+) medicine patients, both POSH (HR: 0.77, 95% CI: 0.71, 0.85, P < .001) and TPOSH (HR: 0.91, 95% CI: 0.83, 0.99, P = .03) were associated with 23 and 9% lower risk of 30-day readmission, respectively, compared to no visit. For medium to low risk medicine patients (LACE< 11) and all surgical patients regardless of LACE score or age, there were no significant associations for either visit type with risk of 30-day readmission.ConclusionsPost-hospital telephone follow-up provider visits had only modest effects on 30-day readmission in high-risk medicine patients compared to clinic visits. It remains to be determined if greater use and comfort with virtual visits by providers and patients as a result of the pandemic might improve the effectiveness of these encounters.
Highlights
Transitional care management after hospital discharge typically includes a follow-up provider clinic visit within 7–14 days depending on patient complexity [1, 2]
We previously reported on the association between completion of a dedicated post-hospital (POSH) follow-up provider clinic visit with a 24% lower risk of 30-day inpatient readmissions in older patients within an integrated health system [3], a finding similar to other studies [4,5,6]
In response to the dramatic shift to greater use of telehealth for routine clinic appointments out of necessity due to the COVID-19 pandemic [7], we aimed to advance the care transition evidence base by using data prior to the public health emergency to examine the effects of clinic (POSH) and telephone (TPOSH) visits completed within 7 days of discharge with a provider on 30-day inpatient and observation stay readmission compared to no visit and whether these effects varied by age, service line and readmission risk as secondary analyses
Summary
Transitional care management after hospital discharge typically includes a follow-up provider clinic visit within 7–14 days depending on patient complexity [1, 2]. In response to the dramatic shift to greater use of telehealth for routine clinic appointments out of necessity due to the COVID-19 pandemic [7], we aimed to advance the care transition evidence base by using data prior to the public health emergency to examine the effects of clinic (POSH) and telephone (TPOSH) visits completed within 7 days of discharge with a provider on 30-day inpatient and observation stay readmission compared to no visit and whether these effects varied by age, service line (medicine or surgical) and readmission risk as secondary analyses. Follow-up visits with clinic providers after hospital discharge may not be feasible for some patients due to functional limitations, transportation challenges, need for physical distancing, or fear of exposure especially during the current COVID-19 pandemic
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